Outcomes for Patients after Resection of Pulmonary Metastases from Clear Cell Renal Cell Carcinoma: 18 Years of Experience

Abstract

Introduction: Clear cell renal cell carcinoma (ccRCC) is the most common kidney tumor. If feasible, metastasectomy is preferably indicated in metastatic disease.

Objective: The aim of this study was to determine the outcome of patients after pulmonary metastasectomy (PM).

Methods: PM for ccRCC was performed in 35 patients in the period of January 2001-2019. Clinical characteristics, type of surgery, histopathology results, and follow-up data were recorded. Progression-free survival (PFS) after PM and overall survival (OS) were defined as outcome endpoints.

Results: A total of 77 PMs were performed in 35 patients after nephrectomy for ccRCC. The mean size of pulmonary metastasis was 19.0 mm (4-90). With a median follow-up after PM of 79.2 months, the 3- and 5-year OS rates were 63.5 and 44.9%, respectively. The only statistically significant prognostic factor affecting both PFS (p = 0.019) and OS (p = 0.015) was the dimension of pulmonary metastases.

Conclusions: The prognosis of metastatic ccRCC is generally poor, particularly in cases of larger size of metastasis. PM might improve the individual prognosis of patients with lung metastasis even in cases with higher number of metastases, bilaterality, synchronous metastasis, or a short progression-free interval after nephrectomy.

Keywords: Clear cell renal cell carcinoma; Metastasectomy; Pulmonary metastasis.